| NPI | 1831140011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD463883) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO DR.0070204) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2023-05-12 |